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Doctors Hospital attacked loopholes for Columbia County facility

An artist's rendering shows the hospital that Doctors Hospital now wants to build in Columbia County.

Months before it filed a bid to build a hospital in Columbia County, Doctors Hospital of Augusta attacked the very loopholes it now wants to exploit to put a facility there.

Doctors, University Hos­pital and Georgia Regents Health System have filed bids in response to Columbia County’s Request for Pro­posals to build at least a 100-bed hospital with a trauma unit in the county, the state’s largest without a hospital. Last year, the Georgia Department of Community Health denied a Certificate of Need to competing proposals from Doctors and University to build a free-standing Emergency Department in Columbia County, saying the county is adequately served by hospitals in Augusta and there is no need for a new facility.

But in conversations with the department, Columbia County officials say they were pointed toward exceptions to the state’s need requirement. The three that would apply are: if the new hospital is part of an existing trauma center; if it is part of an existing teaching hospital; or if the county pays 20 percent of the cost to build it. None of those exceptions have ever been used in Georgia.

University proposed the cheapest option of a 100-bed facility at a cost of $130-$140 million but offered to defer the county’s payment until the end and to give the county the right to appoint some board members. Georgia Regents proposed using the teaching and trauma exceptions so the county pays nothing and it would provide a $280-$310 million health campus with a 144-bed hospital. Doctors proposed using the trauma exception because it hopes to be designated a trauma center this year but, if not, it would work with the county on its share of a $150 million 108-bed hospital.

But even before the county’s RFP went out, Doctors filed a CON Request for Determination on Sept. 20 that asked the department to rule all the exceptions invalid, according to documents obtained by The Augusta Chronicle. In the request, which Doctors filed as “the predominate provider of acute care hospital services to residents of Columbia County,” the hospital argues that there is no support in the legislation to allow for such exemptions and the department “cannot unilaterally create one.”

In further filings, Doctors said the exceptions were proposed by a now-disbanded advisory board and would confer special treatment that is outside its scope of powers.

“The program is not charged with expanding, protecting or incenting trauma hospitals, teaching hospitals, or county-financed facilities,” according to the letter “Whatever the merits of those policy objectives may be, the CON program is not the proper avenue to achieve them, and the General Assembly has not seen fit to authorize exemptions for them.”

The request was filed on behalf of Doctors by Josh Belinfante, a former board member of Georgia Regents Health System. According to his board biography, Belinfante once served as executive counsel to former Gov. Sonny Perdue and “played a key role in the Georgia Certificate of Need legislation” that was revised in 2008.

“The Exemption is simply an anachronistic throwback that erroneously survived the regulatory revisions” in 2008, Belinfante wrote. There are two exemptions to the needs standard written into the CON law, for perinatal services and for destination cancer hospitals, and “the General Assembly could have exempted teaching, trauma, and county-financed hospitals had it chosen, but it did not,” Belinfante wrote.

But in an objection to Doctors’ request, Georgia Regents wrote that it is well within the department’s legal authority to determine how it will judge the need for certain services.

The department “recognized that the need for certain facilities such as teaching hospitals, trauma centers ... and community-funded hospitals cannot be determined using the numeric need methodology due to the unique needs and offerings of these facilities,” according to the Georgia Regents response. Doctors also lacks standing to object, and the request is ill-timed because there is nothing to object to yet because no exemption has been applied, Georgia Regents argued.

But Belinfante counters that “allowing the unauthorized exemption to stand would impair the legal rights of Doctors.”

The department did not agree. It pointed to a rule that says no one can request a determination for an action or proposed action by a third party and therefore “Doctors Hospital’s request is not a proper request,” the department wrote.

Ron Cross, Columbia County Commission chairman, said he did not think Doctors’ request would affect its bid and regardless of which one the county chooses the others are likely to take action. He said an 11-member citizen committee, whose names will be revealed at Tuesday’s commission meeting, will review the three bids and come back with a choice.

“We know it is going to be a fight,” he said. “Two people are going to be unhappy and we are just going to have to face that as we come to it. And see if we can make the best choice, get with our choice and prepare a proposal to be submitted to Community Health and see where it goes from there.”